Late-onset hypogonadism and lower limb vascular complications in men with type 2 diabetes: an observational study in a tertiary care centre

PURPOSE: The aim of this study was to evaluate the relationship between late onset hypogonadism (LOH) with inflammation and lower-limb vascular complications in men with type 2 diabetes (T2D). METHODS: This single-centre, retrospective observational study included men with T2D who underwent hormonal evaluation between 2020 and 2024. LOH was diagnosed according to SIAMS/SIE and EAU guidelines and participants were classified as hypogonadal or eugonadal. Demographic, metabolic, inflammatory, and haematological parameters were collected. Lower-limb vascular complications, including peripheral artery disease (PAD), diabetic foot ulcer (DFU), osteomyelitis and amputation, were assessed. Logistic regression analyses were performed to evaluate the association between testosterone (T) levels and vascular complications. RESULTS: The study population included 155 men, with a prevalence of LOH of 50.3%. Hypogonadal men showed significantly lower haemoglobin and haematocrit levels and higher inflammatory markers compared with eugonadal subjects. Microvascular complications did not differ between groups, except for a higher prevalence of DFU in hypogonadal men. Conversely, macrovascular lower-limb complications were more frequent in men with LOH, including PAD, osteomyelitis, and amputation. Higher T levels were associated with a reduced number of these outcomes. After multivariable adjustment, T levels remained independently associated with the risk of PAD and lower limb amputation. CONCLUSION: In our cohort of men with T2D, hypogonadism is associated with an increased burden of macrovascular and lower limb complications. Lower T levels were independently associated with PAD and amputation, supporting hypogonadism as a marker of vascular impairment.